Journal of the Royal College of Physicians of Edinburgh最新文献

{"title":"Simulation demystified and reimagined-using simulation to transform clinical practices.","authors":"Craig Brown, David Savage","doi":"10.1177/14782715251365452","DOIUrl":"10.1177/14782715251365452","url":null,"abstract":"<p><p>Simulation has traditionally been used for paedagogical purposes. More recently, simulation has been advocated for use in transformational ways - leveraging simulation to test and improve clinical systems and service delivery. This article presents a narrative account of transformational simulation in stroke care. We describe three simulation-based initiatives: a review of simulation on door-to-needle times, development of a telethrombolysis protocol and implementation of a thrombectomy pathway. This article demonstrates how simulation can be used to transform healthcare. Our examples have focussed on stroke presentations; however, the 'seven I's model' outlines how simulation can be used to identify, improve and innovate across the care spectrum.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"224-227"},"PeriodicalIF":0.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144862531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remarks on delirium assessment, management and barriers to effective care across Scotland.","authors":"Fnu Wajeeha, Sohaib Raza, Zernain Toor","doi":"10.1177/14782715251344462","DOIUrl":"10.1177/14782715251344462","url":null,"abstract":"","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"234-235"},"PeriodicalIF":0.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast cancer-related lymphedema triggered and exacerbated following Ramadan fasting: Report of two cases.","authors":"Hossein Yarmohammadi, Amirmahdi Taromiha, Masood Soltanipur, Zahra Sheikhi","doi":"10.1177/14782715251362064","DOIUrl":"10.1177/14782715251362064","url":null,"abstract":"<p><p>Breast cancer-related lymphedema (BCRL) is a chronic condition affecting breast cancer survivors (BCSs), leading to symptoms such as swelling. We present two cases of BCSs who developed complications related to BCRL after fasting during Ramadan month. The first case involved a 47-year-old woman who experienced stage 2a BCRL, while the second case was a 64-year-old woman with stage 3 BCRL complicated by cellulitis. Both patients underwent treatment, including complete decongestive therapy, resulting in significant symptom improvement. These cases suggest that fasting may exacerbate or develop BCRL symptoms, emphasising the need for individualised dietary guidance for BCSs to prevent complications. Further research is essential to assess dietary effects on BCRL management. This association warrants further prospective evaluation in larger cohorts to better understand the relationship between fasting and BCRL.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"193-196"},"PeriodicalIF":0.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Overlap of limited cutaneous systemic sclerosis with ocular myasthenia gravis- report of a case and a brief review of literature.","authors":"Harikrishnan Gangadharan, Sandra Pulickal Babu, Rohit Ram Kumar, Aditya Nair, Manjit Ps, Jacob George","doi":"10.1177/14782715251362060","DOIUrl":"10.1177/14782715251362060","url":null,"abstract":"<p><p>A 39-year-old woman with a 4-year history of limited cutaneous systemic sclerosis (lcSSc) and no prior exposure to D-penicillamine presented with bilateral fluctuating ptosis of 1 week duration. On evaluation, she was found to have elevated acetylcholine receptor antibody levels and a positive neostigmine test confirming the diagnosis of ocular myasthenia gravis (MG). The patient was treated with oral prednisolone and pyridostigmine resulting in significant improvement within 2 weeks. The co-occurrence of systemic sclerosis (SSc) and MG is rare and when such an association is seen, it is usually seen in the background of D-Penicillamine therapy for SSc. The presence of fluctuating ptosis in SSc is a valuable clinical clue to suspect co-existence of neuromuscular junction disorder like MG.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"188-192"},"PeriodicalIF":0.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remarks on 'do low-risk patients really need follow-up after a pulmonary embolism?': Reassessing the role of structured care in PE management.","authors":"Sohaib Raza, Zernain Toor, Haider Ali, Ahmad Faraz","doi":"10.1177/14782715251355533","DOIUrl":"10.1177/14782715251355533","url":null,"abstract":"","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"238-239"},"PeriodicalIF":0.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144530234","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postgraduate doctors in training's limited knowledge and practice in the assessment and management of inpatients with diabetes and frailty may contribute to suboptimal outcomes.","authors":"Hnin Lwin, Anu Thomas, Mohamed Fazil, Kevin Thottungal, Garima Gupta, Kashish Gera, Ali Kareem, Sadaf Saeed, Meri Davitadze, Eka Melson, Alison Gallagher, Kath Higgins","doi":"10.1177/14782715251362057","DOIUrl":"10.1177/14782715251362057","url":null,"abstract":"<p><strong>Introduction: </strong>People with diabetes and frailty require less intensive treatment of hyperglycaemia. Previous study has shown low rates of HbA_1c assessment and deintensification for people with diabetes and frailty. Postgraduate doctors in training (PGDiT) is important in the inpatient management of people with diabetes and frailty. This study aims to assess the knowledge and management practice amongst PGDiT in managing people with diabetes and frailty and how this may translate to patients' clinical outcomes.</p><p><strong>Methods: </strong>Three cross-sectional survey-based studies were conducted on PGDiT at the beginning of each 4-month rotation. Survey questions incorporated knowledge of HbA_1c goals and on PGDiT deintensification practice in people with diabetes and frailty who are overtreated with blood glucose-lowering medication. These were coupled by two cross-sectional data collection on patients' outcomes conducted during the same period including HbA_1c assessment and rates of deintensification.</p><p><strong>Results: </strong>PGDiT survey: 160 PGDiT responded to the survey. 80.0% (<i>n</i> = 128/160) of PGDiT reported that they knew the target HbA_1c in patients with diabetes and frailty. However, only 32.8% (<i>n</i> = 42/128) of these correctly indicated the target HbA_1c for such patients. PGDiT deintensification practices were lower than expected and several barriers of inpatient deintensification were identified. Patients' clinical outcomes: 198 patients with diabetes and moderate-severe frailty were included in our analysis (median (interquartile range, IQR) age 80 (71-87) years with median (IQR) clinical frailty scale of 6 (6-7)). For patients who did not have their HbA_1c assessed in the last 6 months preceding admission, only 18.1% (<i>n</i> = 13/72) had it assessed during admission. In patients who are overtreated, deintensification rate was 29.7% (<i>n</i> = 22/74).</p><p><strong>Conclusion: </strong>Our audit shows limited knowledge and management practices amongst PGDiT in the management of inpatients with diabetes and frailty that may contribute to low inpatient deintensification rate. Interventions are needed to improve patient outcomes and a model of care consisting of appropriate inpatient multidisciplinary team input to reduce treatment inertia.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"174-183"},"PeriodicalIF":0.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Teaching forensic medicine in eighteenth-century Scotland.","authors":"Daisy Cunynghame","doi":"10.1177/14782715251367542","DOIUrl":"10.1177/14782715251367542","url":null,"abstract":"<p><p>Analysing the handwritten notes recorded by students who attended the classes of Andrew Duncan, Professor of the Institutions of Medicine at the University of Edinburgh, the article uncovers the contents of Britain's first forensic medicine lecture series. It explores not only aspects of forensic medicine distinctive to the late eighteenth century but also uncovers elements of forensic teaching which were distinctly Scottish and distinctly related to the background, connections and experiences of the courses' creator. The article uncovers the methodology for examining a crime scene which the notes describe, as well as the investigative techniques used in the examination of alleged cases of abortion, rape and murder. Finally, the article reflects on the role physicians were expected to play in the identification of fictitious diseases - diseases, allegedly, falsified to elicit charity, avoid military conscription or to avoid work.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"209-215"},"PeriodicalIF":0.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145137510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Palmoplantar keratoderma with mottled pigmentation: A clue to chronic arsenicosis.","authors":"Shreya K Gowda, Priya Yadav","doi":"10.1177/14782715251342134","DOIUrl":"10.1177/14782715251342134","url":null,"abstract":"<p><p>Arsenical keratosis is a precancerous skin condition resulting from chronic exposure to arsenic, typically through ingestion of contaminated water, food (notably rice), certain medications, or tobacco products. Exposure can also occur via industrial and environmental sources, including some herbal remedies. According to the World Health Organization, a minimum of six months of exposure above safe limits is required to develop toxicity, with cutaneous manifestations appearing anywhere from 4 to 40 years later. Clinically, it presents as thick, painful, keratotic lesions on the palms and soles, often with accompanying pigmentary changes such as a raindrop pattern. Chronic arsenic toxicity may also cause systemic symptoms involving the nervous, hepatic, pulmonary, and gastrointestinal systems.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"197-199"},"PeriodicalIF":0.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using electronic health records to identify computed tomography brain features associated with post-stroke dementia: A feasibility study.","authors":"Emily L Ball, Gillian E Mead, Terence J Quinn, Dorota Religa, Joanna M Wardlaw, Susan D Shenkin","doi":"10.1177/14782715251358924","DOIUrl":"10.1177/14782715251358924","url":null,"abstract":"<p><strong>Background: </strong>We explored the feasibility of linking research datasets to electronic health records to identify acute stroke computed tomography (CT) brain features associated with post-stroke dementia.</p><p><strong>Methods: </strong>We linked data from two existing research datasets of people who had a stroke. These datasets contained expert-coded features from CT brain scans. Participants were followed up by linking to their electronic health records. Survival analyses were performed to identify prognostic factors associated with increased risk of post-stroke dementia.</p><p><strong>Results: </strong>Twenty-one participants (11%, <i>n</i> = 21/185) were identified as having dementia after stroke (median follow-up: 9 years and 8 months). Presence of cerebral atrophy and moderate-to-severe white matter hyperintensities on acute stroke CT scans were associated with an increased risk of post-stroke dementia.</p><p><strong>Conclusion: </strong>Linkage to electronic health records is a feasible method for studying dementia outcomes after stroke. This method can be applied to larger stroke populations to explore acute stroke imaging predictors in more detail.</p>","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"169-173"},"PeriodicalIF":0.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bluish diffuse discolouration over infusion site.","authors":"Shreya K Gowda, Vanshika Arora, Surabhi Jain, Sonali Dixit, Neha Taneja","doi":"10.1177/14782715251349642","DOIUrl":"10.1177/14782715251349642","url":null,"abstract":"","PeriodicalId":46606,"journal":{"name":"Journal of the Royal College of Physicians of Edinburgh","volume":" ","pages":"236-237"},"PeriodicalIF":0.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144310572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}